patient summary

PsychEducation.org
Quality Mental Health Information on Specific Topics
Jim Phelps, M.D. Corvallis, OR ( Home)

"Wait a minute -- do I really need to know this?"

Prevalence of bipolar variants in primary care depression has been reported as high as 30%^Manning. Obviously this means that of all your patients with depression, as many as one in three might have a bipolar variation. You will learn here that antidepressants may even worsen bipolar disorder, and that mood stabilizers you can learn to use are the treatment of choice. At minimum, for your patients who have not improved on antidepressants and psychotherapy, consider Bipolar II. Read on to learn more about this diagnosis.

Here's a quick summary of what you'll find in the provider guide. The references are annotated and hyperlinked, if you want more information on anything in particular.

1. Diagnosis
Bipolar disorder isn't just "manic-depressive" anymore. Mood experts are in agreement: there are versions of bipolar disorder that don't manifest full "mania" yet respond very well to mood stabilizer medications (lithium, valproate, carbamazepine; and some newer ones). These variants can be lumped under "bipolar II", an official DSM diagnosis now.

2. Treatment
Primary care providers see mood disorders all the time; some see several per day. You can learn how to manage lithium and valproate on this site, and you will thus have new options for complex depressions. You will have something to try, if you have no place to refer the patient.

3. Screening
How can you identify patients who might have some degree of "bipolar" that makes them at risk if given an antidepressant? Without taking more than an additional minute? Use a screening form for bipolar disorder: leave it with the patient and see your next one. You can download, save and print one from the Resource Center on this site. Click here to go straight to that screening tool.

Below you can see an outline of the full site. Click to go there.

SITE OUTLINE

TRUST

Why is Dr. Phelps doing this?
Caveats

DIAGNOSIS

What happened to "manic-depressive" (now bipolar I)?
What are the official (DSM-IV) definitions of the "new" bipolar variations?
Anxious depression could be "bipolar"?!
What is the "depression spectrum?"
What do "bipolar variations" look like?
How do you rule out bipolar disorder now?
Appendix: More Diagnosis Details

TREATMENT

What are the most important principles of bipolar disorder treatment?
Can I really treat BPII in my office?: step-by-step for a new patient
Individual mood stabilizer guidelines:

lithium
valproate
which one first?

Does one really have to minimize antidepressants?
Appendix: More Treatment Details

PATIENT HANDOUTS

REFERENCES (>100)

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